digital art article 91 2010 pdf

digital art article 91 2010 pdf

zonker20566    April 28, 2023    Comment   

Digital analysis of works of art and their agents should never be severed from the historical social and economic contexts in which the art was created displayed bought and sold and in which the various agents involved in all these processes operated

1 1 the digital art world in its broadest extant sense digital art refers to art that relies on computer based digital encoding or on the electronic storage and processing of information in different formats text numbers images sounds in a common binary code

Pdf digital technology it 39 s role in art creativity home psychology personality psychology creativeness digital technology it 39 s role in art creativity october 2018 authors archana rani

Critical Factors Influencing The Adoption Of Digital Marketing Devices By Service Oriented Micro Businesses In Nigeria: A Thematic Analysis Approach

This article forms a descriptive study of the presence of digital art which has been signified by three extraordinary occurrences i e the presence of the world of art as based on

In the 21 st century digital art has become more entrenched in everyday existence today it is par for the course to see much conceptual video internet social media and multimedia art utilizing digital tools and media without specific alignment with the digital art movement

The uniform code of military justice ucmj articles are all below this website is meant to make it easy and simple to reference all ucmj articles for members of the united states military and department of defense employees the below ucmj articles apply to all uniformed united states military branches which includes the marines navy coast

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Article 91 has the same general objects with respect to warrant noncommissioned and petty officers as articles 89 and 90 have with respect to commissioned officers namely to ensure obedience to their lawful orders and to protect them from violence insult or disrespect

In this study digital art is defined as an artistic work or practice that uses digital technology as part of the creative or presentation process paul 2008 digital art started in the 1960s as a new form of media art agyeman 2014 edmonds 2019 heck 2017

Pdf on aug 3 2020 fitri murfianti published hak cipta dan karya seni di era digital find read and cite all the research you need on researchgate

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Heitlinger interrogates sheridan 39 s concept of digital live art with the help of the interactive piece talking quilt the role of the audience in relation to the digital performance is described in digital live art through wittingness the level of knowingly participating in it

Digital tools refer to software applications in the production of artworks particularly in painting digital art work is materialized by using computers software and a combination of computer peripherals such as tablet support with the aid of electronic equipment digital artists manipulate pixels or coloring with light to compose

This article explores digital art styles and types digital art leverages the power of technology with human creativity to create dynamic pieces unlike ever before despite being a newer facet of art digital art has branched out into its unique subgenres and styles

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Articles on digital art displaying 1 20 of 26 articles february 27 2023 is there a way to pay content creators whose work is used to train ai yes but it s not foolproof brendan paul

Digital art is a catch all term for the creation or manipulation of artistic media via technology this can include everything from pixel art to photo manipulations to 3d digital sculpting

Abstract in the past two decades art and technology have increasingly become inseparable technology in this case the internet has produced a new era known as the digital era followed by the emergence of many problems one of which is in the field of copyright there are many cases of copyright infringement committed by art creators and the

Gatekeeping In The Digital Age

Article 91 concepts article 91 has the same general concepts with respect to warrant noncommissioned and petty officers as articles 89 and 90 have with respect to commissioned officers namely to ensure obedience to their lawful orders and protect them from violence insult or disrespect

Just like traditional fine art digital art offers multiple mediums and styles that artists can use to express themselves from digital photography computer graphics and pixel art to more experimental mediums such as ai generated art and ar art everything goes in the spectrum of digital art

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Hasil dari penelitian ini adalah berupa buku edukasi sadar undang undang ite menggunakan teknik digital painting dalam penggunaan media sosial pada anak usia 12 15 tahun dengan keyword farsighted sebagai dasar dari konsep perancangan media pendukung yang akan digunakan berupa x banner stiker bolpoint dan poster export record

digital art vocabulary jam join sql server

digital art vocabulary jam join sql server

zonker20566    April 28, 2023    Comment   

Using equi joins is the most common way to join tables but it s possible to use other sql operators such as like not like or even between in on clause search conditions be aware though that using more complicated search conditions can make it difficult to predict what data will appear in the result set

Sql join a join clause is used to combine rows from two or more tables based on a related column between them notice that the customerid column in the orders table refers to the customerid in the customers table the relationship between the two tables above is the customerid column

When ansi standard sql or ansi sql is mentioned it refers to the sql standard and is included in all databases that adopt the standard mysql oracle sql server etc in oracle sql there are two methods of joining tables the oracle method using signs and the ansi standard method using join keywords

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Digital art electronic artistic work or practice images composed of bits and bytes of computer memory created on a computer using software and in some cases hardware digital sources come from scans photos downloads or drawing tablets

In more technical terms a database instance is a collection of processes and temporary memory structures that allow the database system to work database server and client one sql inc building consolidates its files and sends them to be viewed by people outside the building organization

Joining two different tables on their matching columns can be done using nested loops but a more efficient and scalable way is to use multimaps the idea is to map from each column value that we want to join to all the rows that contain it to generate a multimap from a table out of both tables the multimap generated has to be hash based

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Internet art often referred to as net art is a term used to describe a process of making digital artwork made on and distributed by the internet this form of art has circumvented the traditional dominance of the gallery and museum system delivering aesthetic experiences via the internet

Digital art is work made with digital technology or presented on digital technology this includes images done completely on computer or hand drawn images scanned into a computer and finished using a software program like adobe illustrator

In general the solution is to add days to the time value which has zero for its day portion you are not clear as the data types of the two values however one solution would be with inputs as select 39 20110302 39 as dateval 39 10 34 am 39 as timeval select dateadd d datediff d 0 cast dateval as datetime cast timeval as datetime

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Aug 9 2018 at 14 21 add a comment 4 answers sorted by 9 you can try declare hours decimal 7 4 20 5599 select cast convert varchar dateadd second hours 3600 0 108 as time output 20 33 35 but remember type time in mssql only under 24hrs if you want greater than 24hrs try

Destination document in digital art this is the document where the artist places digital selections to manipulate with software to create a completed work of art it is like the painter s canvas or the drawer s paper the expression is used by this instructor in her digital art class

Jamstack has become a major trend in web development originally coined by ceo of netlify jamstack has been described as a modern web development architecture that is based on client side

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This book guides you step by step through every phase of filestream implementation from enabling the feature to creating filestream tables to manipulating filestream data through the streaming apis we also cover in detail administration and troubleshooting of filestream databases and tables

Sql server is a relational database management system one of the key principles of the relational database is that data is stored across multiple tables we will need to be able to join tables together in order to extract the data we need we use primary and foreign keys to join tables

Reconsidering the terms we use to define digital art tabor robak newborn baby 2015 image courtesy of team gallery inc the word digital in reference to art is one that still tends to make many cringe though no one really talks about digital movies or music at this point with digital distribution methods dominating their

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Glossary of terms for digital art ms millis abstract a type of image which has been simplified but retains a visual to something recognizable abstraction simplification of a recognizable image to its essential characteristics acetate transparent or semi transparent plastic sheet used to protect scanner glass artwork or as an art surface

This course assumes users have little to no sql experience so there s no prerequisite if you have a familiarity with tms and how your institution manages data that would be a very good starting point for this class brian supporting tms users at the gallery systems user conference

There are different types of joins in sql in this article only operations on inner joins in mssql are discussed inner join is the method of retrieval of data from multiple tables based on a required condition and necessary conditions are that there must be common columns or matched columns between the two tables of the database and the data

Do You Know]

Take sql practice set in ms sql server and refine your skills with 88 interactive exercises ranging from simple tasks with select from statements to more advanced problems involving multiple subqueries tests your basic sql server knowledge and get to know where you need to improve

As developers we know sql joins are foundational and oftentimes required in order to retrieve the correct data the query builder class has a dedicated join method you can use when constructing queries where joins are necessary continue reading and learn how to use the codeigniter 4 query builder join method

1 in sql server connections an instance of sql server running on the same computer as the application 2 in a transact sql statement when resolving references to database objects the instance of sql server executing the statement 3 in sql server distributed queries the instance of sql server executing the distributed query

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Sql server uses the database dictionary to verify sql statements when you execute a sql statement the dbms database management system parses the statement and then determines whether the tables and fields you are referencing are valid to do this quickly it references the data dictionary

digital art wikipedia jeffersonian institute

digital art wikipedia jeffersonian institute

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The Jeffersonian Institute is a governmental institution, and the home to the Medico-Legal Lab, which consists of a team of forensic specialists that frequently consult with FBI Special Agent Seeley Booth.

In reality, the building shown is the Dr. Theodore T. Alexander, Jr. Science Center School at 3737 S Figueroa St, Los Angeles, CA. In this shot, we see the back door which faces the gardens.

Where Brennan and her team do their work by examining the bodies of the deceased or murdered victims that have been found. The area where the bones or corpses of the deceased are stationed is guarded by an invisible laser to keep the remains and possible evidence safe from contamination or tampering. In order for them to access the area, each employee must swipe their ID card into the machine at the entrance which in turn grants them entry. Failure to do so will result in a loud alarm being triggered that will only stop once another ID card has been inserted into the machine. Various guards are regularly seen stationed in or outside the area. All the employees at the Jeffersonian possess ID cards, with Booth later receiving his own ID card courtesy of Brennan although it is rarely ever seen.

John F. Kennedy Center For The Performing Arts

Whenever she's not in the field or working on bodies, Brennan spends most of her time in her own office, filing reports, doing paperwork and also writing up her next possible novel.

Where Angela does her own work and also uses her own specially designed computer system (known as the 'Angelator' and later the 'Angelatron') to give the team a glimpse or an insight into what the victims looked like before decay left their bodies unrecognizable as well as possibilities into how they died.

Hodgins' Office In the first three seasons Hodgins often worked at a lone desk in the Forensic Area but in recent seasons, he moved into Zack's old office, unwillingly. This is also the place Zack and Hodgins often did their experiments. In addition, Hodgins regularly keeps some of his bugs here. He discovered that the Jeffersonian was a Masonic Construction through the claims of a Conspiracy Group. There is a fake wall in the janitor's closet that covers a ladder that leads to the Archives beneath the Jeffersonian.

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Located on the mezzanine level of the Jeffersonian Institute's Medico-Legal Lab, overlooking the forensic platform, it is the area where Brennan and her team usually go for meetings or if they just want to hang out after a tough case.

Where the skeletal remains of the victims are usually located. Brennan and her team usually go there to see if they can find anything else in regards to the bones. Brennan was shot in the room while she examined some bones.

Where Cam performs her own autopsies on the victim's remains before they are taken away to have their flesh removed so that Brennan and her team can look at the bones to identify the victim, locate forensic evidence, or find any possible causes of death.

Berkas:thomas Jefferson By Rembrandt Peale, 1800.jpg

A long hallway containing numerous boxes of bones belonging to people who have not been identified. Also referred to as "Limbo", though both Dr. Goodman and Dr. Brennan object to the term. Later in the series, everyone started to call it Limbo.This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and wh to remove these template messages)

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Digital art refers to any artistic work or practice that uses digital technology as part of the creative or prestation process. It can also refer to computational art that uses and gages with digital media.

Lillian Schwartz's Comparison of Leonardo's self-portrait and the Mona Lisa is based on Schwartz's Mona Leo. An example of a collage of digitally manipulated photographs

Medico Legal Lab

John Whitney, a pioneer of computer graphics, developed the first computer-gerated art in the early 1960s by utilizing mathematical operations to create art.

Andy Warhol created digital art using an Amiga where the computer was publicly introduced at the Lincoln Cter, New York, in July 1985. An image of Debbie Harry was captured in monochrome from a video camera and digitized into a graphics program called ProPaint. Warhol manipulated the image by adding color by using flood fills.

Digital art can be purely computer-gerated (such as fractals and algorithmic art) or tak from other sources, such as a scanned photograph or an image drawn using vector graphics software using a mouse or graphics tablet. Artworks are considered digital paintings wh created similarly to non-digital paintings but using software on a computer platform and digitally outputting the resulting image as painted on canvas.

University Of Virginia

Amidst varied opinions on the pros and cons of digital technology on the arts, there seems to be a strong conssus within the digital art community that it has created a "vast expansion of the creative sphere", i.e., that it has greatly broaded the creative opportunities available to professional and non-professional artists alike.

Digital visual art consists of either 2D visual information displayed on an electronic visual display or information mathematically translated into 3D information viewed through perspective projection on an electronic visual display. The simplest is 2D computer graphics which reflect how you might draw using a pcil and a piece of paper. In this case, however, the image is on the computer scre, and the instrumt you draw with might be a tablet stylus or a mouse. What is gerated on your scre might appear to be drawn with a pcil, p, or paintbrush. The second kind is 3D computer graphics, where the scre becomes a window into a virtual vironmt, where you arrange objects to be "photographed" by the computer. Typically 2D computer graphics use raster graphics as their primary means of source data represtations, whereas 3D computer graphics use vector graphics in the creation of immersive virtual reality installations. A possible third paradigm is to gerate art in 2D or 3D tirely through the execution of algorithms coded into computer programs. This can be considered the native art form of the computer, and an introduction to the history of which is available in an interview with computer art pioneer Frieder Nake.

To create three-dimsional objects and sces for use in various media such as film, television, print, rapid prototyping, games/simulations, and special visual effects.

Artificial Intelligence Art

There are many software programs for doing this. The technology can able collaboration, lding itself to sharing and augmting by a creative effort similar to the op source movemt and the creative commons in which users can collaborate on a project to create art.

Pop surrealist artist Ray Caesar works in Maya (a 3D modeling software used for digital animation), using it to create his figures as well as the virtual realms in which they exist.

Computer-gerated animations are animations created with a computer from digital models created by 3D artists or procedurally gerated. The term is usually applied to works created tirely with a computer. Movies make heavy use of computer-gerated graphics; they are called computer-gerated imagery (CGI) in the film industry. In the 1990s and early 2000s, CGI advanced ough that, for the first time, it was possible to create realistic 3D computer animation, although films had be using extsive computer images since the mid-70s. A number of modern films have be noted for their heavy use of photo-realistic CGI.

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Mainly refers to the process of creating paintings on computer software based on computers or graphic tables. Through pixel simulation, digital brushes in digital software (see the software in Digital painting) can imitate traditional painting paints and tools, such as oil, acrylic acid, pastel, charcoal, and airbrush. Users of the software can also customize the pixel size to achieve a unique visual effect (customized brushes).

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Since their design in 2014, some artists have created artwork using a gerative adversarial network (GAN), which is a machine learning framework that allows two "algorithms" to compete with each other and iterate.

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It is usually used to let the computer find the best solution by itself. It can be used to gerate pictures that have visual effects similar to traditional fine art. The esstial idea of image gerators is that people can use text descriptions to let AI convert their text into visual picture contt. Anyone can turn their language into a painting through

digital art apps free online editor freelancer definition

digital art apps free online editor freelancer definition

zonker20566    April 27, 2023    Comment   

Freelancers often take on multiple projects with different clients simultaneously the internal revenue service irs considers freelancers to be self employed individuals freelancers handle contract work on a part time or full time basis and often sign agreements before starting projects

The best digital art drawing software of 2023 in full image credit adobe 1 adobe photoshop best digital art drawing software overall specifications operating system windows macos

Krita digital painting creative freedom krita is a professional free and open source painting program it is made by artists that want to see affordable art tools for everyone concept art texture and matte painters illustrations and comics get krita now

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Fast drawing for everyone autodraw pairs machine learning with drawings from talented artists to help you draw stuff fast

Create digital artwork to share online and export to popular image formats jpeg png svg and pdf sketchpad draw create share sketchpad free online drawing application for all ages

Digital art art design pixel art digital art jobs see more need full twitch overlay pack panels alerts and emotes hourly posted 3 days ago less than 30 hrs week hours needed less than 1 month duration intermediate experience level

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Fotor 39 s online digital art effects do an excellent job of converting self image into digital portraiture and you can experience being a digital artist it only needs a few seconds without any photo editing skills everyone can create stunning digital art with ai go art now

Shortcuts quickly switch tools change brush size copy to clipboard browser storage remember your work for another session cross platform windows mac linux android ipad etc

Create digital artwork to share online and export to popular image formats jpeg png svg and pdf sketchpad draw create share sketchpad free online drawing application for all ages

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A digital editor is responsible for taking consumer targeted web content from concept to publication this is done by overseeing a diverse team of staff and freelance contributors and coordinating with internal marketing departments

Digital art applications are an innovative medium for artists that allow them to draw sketch write and color moreover they can create art through different devices like mobile phones tablets and laptops the most widely known digital art applications are adobe illustrator procreate and affinity designer

A digital artist is someone who uses these tools to bring client 39 s ideas and visions to life through powerful creativity and an eye for detail a digital artist creates art through vector images illustrations fonts cartoons character design animation 2d 3d design websites apps and more

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We have curated a list of the 47 best free and paid drawing appsfor 2023 to express your ideas in the form of digital art here are our top 7 picks for the best drawing apps and art apps adobe photoshop adobe photoshop sketch adobe illustrator adobe illustrator draw autodesk sketchbook astropad studio affinity designer

Freelancer com is home to thousands of freelancers with a broad variety of editing skills in a variety of niches connecting with top ranking editing freelancers is simple post a job and within minutes you will begin to attract the attention of hundreds of freelancers from throughout the globe interested in completing your task

The award winning digital art app lets you easily create sketches illustrations and more anytime and anywhere you can choose from more than 200 handcrafted brushes import custom ones and even make your own using the powerful brush engine procreate includes many features that have been developed exclusively for ipads

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Medibang paint pro view image credit getty images lithiumcloud when it comes to the best digital art software there is more than ever before from paint simulation software and apps designed for photo editing that can be adapted to digital art and even drawing on the go using ipad

Artweaver offers a free or paid version to download the free option is streamlined with plenty of functionality artweaver pro adds new brush types better software integrations and tons of manageability options it s also much more affordable than other paid editions

The ios app allows you to easily swap out brushes undo rogue marks develop custom color palettes and switch between layers of canvas while its responsive touch mimics the analog acts of drawing and painting as pressing harder on the screen will produce heavier lines

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25 canva another software program freelance writers should use is canva canva is a free image editing app that gives you templates for many graphics online for example you can create e books in canva or create pdf and guides social media posts youtube thumbnails and more

A freelance editor edits videos photos or written content articles blogs technical papers on a freelance or contractual basis as a freelancer they may work with multiple clients at a time but may also have only one client for a fixed period depending on their preferences

The majority of online editor jobs pay between 31 57 000 suggesting that opportunities are ripe for advancement and increased pay based on skill level and experience in other words the more of an experienced editor you are the more money you ll bring in learn more about getting paid in the definitive guide to freelance contracts

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6 sketchbook sketchbook is developed by design software giant autodesk creator of autocad among others this android painting app gives you useful tools and features to design whatever your imagination creates a one point sketchbook was a premium app but in recent years autodesk has made the app free

digital art usernames ideas para dibujarla

digital art usernames ideas para dibujarla

zonker20566    April 27, 2023    Comment   

For many artists, finding an art username is a very personal and thoughtful process that involves a lot of thinking, research, and brainstorming. A good art username should be something special and unique that conveys the artist’s personality.

Our online handle is the first thing people think of when they meet us online. It’s a chance to put our best foot forward and make a good impression.

We’re all looking for a name that’s memorable, easy to spell, and easy to pronounce. This is an important decision, so it’s understandable that it may take some thought and effort to find the perfect username.

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Deciding on an art Instagram name is an important decision for any aspiring artist! Here are some steps to follow if you are unsure of how to come up with a good art Instagram name.

Some of the best art usernames are the ones that show off an interesting personality trait or are a play on a person’s favorite activity.

So, you need to choose a creative username that defines you and will get people interested in your artwork. It is a great way to help people to get to know you better.

File:anatolian Hieroglyph A412.svg

If you want to be taken seriously in the art world it is important to avoid usernames that you might later regret.

No matter what you do, you should always think about the future. This advice is especially true if you’re using a username for the internet, where what you post might not be deleted when you decide to change your name.

Even if you don’t have any followers on Instagram, your art Instagram name should still be easy to remember, pronounce, and spell.

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If a friend is telling another friend about you and your art, they will have to say your name. It shouldn’t take a lot of time for them to talk about you. If it does, that friend might get so frustrated that they decide not to talk about you at all.

While some of the top accounts have names that are as long as the average person’s name, most use a simple handle that says a lot about who they are and what they do.

If you want your page to pop up in search results and get a lot of interactions, you need to keep your art Instagram name short and catchy.

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We live in a world of 7 billion people. There’s a lot of room for everyone to be different. There’s a lot of room for everyone to be themselves.

And it’s the same in the Instagram community, right? Well, not exactly. We’ve noticed a disturbing trend on the photo-sharing site: an alarming number of users are using the same username as someone else.

For example, if you choose a name that is a derogatory word towards a certain gender or race. That would be offensive to that gender or race if you used it in your art Instagram username.

Art Book And Stuff Random

The artworld is home to many intriguing names. It’s often the names that first get our attention, and can even help shape our perceptions about an artist’s work.

At first glance, you might think that the name “Jackson Pollock” has no connection to art or his work. But it’s not about how it sounds, it’s about how it looks.

The letters “pollock” and the letters “Jackson” are connected by a series of lines that look a lot like paint drips. You don’t need to be an art history major to appreciate that!

Grocery Store Clip Art Graphic By Clipartisan · Creative Fabrica

underwater digital arthritis symptoms icd

underwater digital arthritis symptoms icd

zonker20566    April 27, 2023    Comment   

ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.

While WHO manages and publishes the base version of the ICD, several member states have modified it to better suit their needs. In the base classification, the code set allows for more than 14, 000 differt codes

And permits the tracking of many new diagnoses compared to the preceding ICD-9. Through the use of optional sub-classifications, ICD-10 allows for specificity regarding the cause, manifestation, location, severity, and type of injury or disease.

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The adapted versions may differ in a number of ways, and some national editions have expanded the code set ev further; with some going so far as to add procedure codes. ICD-10-CM, for example, has over 70, 000 codes.

The following table lists the chapter number (using Roman numerals), the code range of each chapter, and the chapter's title from the international version of the ICD-10.

Countries use ICD-10 for reimbursemt and resource allocation in their health system, and some have made modifications to ICD to better accommodate its utility. The unchanged international version of ICD-10 is used in 117 countries for performing cause of death reporting and statistics.

International Classification Of Diseases (icd) (ieko)

Introduced in 1998, ICD-10 Australian Modification (ICD-10-AM) was developed by the National Ctre for Classification in Health at the University of Sydney.

ICD-10 was implemted in July 2005 under the auspice of the National ICD-10 Implemtation Task Team which is a joint task team betwe the National Departmt of Health and the Council for Medical Schemes.

The ICD-10-CM and ICD-10-PCS were developed by the Cters for Medicare and Medicaid Services (CMS) and the National Cter for Health Statistics (NCHS).

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There are over 70, 000 ICD-10-PCS procedure codes and over 69, 000 ICD-10-CM diagnosis codes, compared to about 3, 800 procedure codes and roughly 14, 000 diagnosis codes found in the previous ICD-9-CM.

There was much controversy wh the transition from the ICD-9-CM to the ICD-10-CM was first announced in the US. Many providers were concerned about the vast number of codes being added, the complexity of the new coding system, and the costs associated with the transition.

The Cters for Medicare and Medicaid Services (CMS) weighed these concerns against the befits of having more accurate data collection, clearer documtation of diagnoses and procedures, and more accurate claims processing.

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CMS decided the financial and public health cost associated with continuing to use the ICD-9-CM was too high and mandated the switch to ICD-10-CM.

The deadline for the United States to begin using ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatit hospital procedure coding was set at October 1, 2015,

All HIPAA "covered tities" were required to make the change; a pre-requisite to ICD-10-CM is the adoption of EDI Version 5010 by January 1, 2012.

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Forcemt of 5010 transition by the Cters for Medicare & Medicaid Services (CMS), however, was postponed by CMS until March 31, 2012, with the federal agcy citing numerous factors, including slow software upgrades.

The implemtation of ICD-10-CM has be subject to previous delays. In January 2009, the date was pushed back to October 1, 2013, rather than an earlier proposal of October 1, 2011.

Two common complaints in the United States about the ICD-10-CM are 1) the long list of pottially relevant codes for a giv condition (such as rheumatoid arthritis) which can be confusing and reduce efficicy and 2) the assigned codes for seldom se conditions (e.g. W55.22XA: Struck by cow, initial counter; and V91.07XA: Burn due to water-skis on fire, initial counter).

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The expansion of healthcare delivery systems and changes in global health trds prompted a need for codes with improved clinical accuracy and specificity.

Early concerns in the implemtation of ICD-10 included the cost and the availability of resources for training healthcare workers and professional coders.The seed of sufferingThe p-factor is the dark matter of psychiatry: an invisible, unifying force that might lie behind a multitude of mental disorders

Alex Riley is a science writer whose work has been published by the BBC, New Scientist and Nautilus, among others. He is the author of A Cure for Darkness: The Story of Depression and How We Treat It (2021). He lives in Bristol, UK.

Icd 10 2nd Ed_volume2

The voices told him that he was God, and Oliver believed them. Only 17 years old, he was special, chosen, a higher being whose wisdom and intelligence were beyond compare. Psychiatrists, however, labelled these voices as auditory hallucinations, his first psychotic episode. A diagnosis of schizophrenia soon followed. For the next five years, Oliver would spend weeks in mental institutions and hospitals in northern England where he lived. When he was deemed too aggressive for one facility, he was injected with sedatives, bundled into the back of a van and driven to a higher-security institution. The drugs made the voices distant. Oliver felt subdued and heavy as he fell back to Earth.

Five years have passed. Although he is unemployed, Oliver is now able to live at home with his wife and young daughter. He takes clozapine, an antipsychotic that’s prescribed to patients who don’t respond to two first-line drugs such as olanzapine and quetiapine. It’s a last resort for a reason: clozapine is a toxic medicine that reduces the number of white blood cells in his body, so Oliver has regular blood tests to make sure he isn’t immune-compromised, a concern that has grown during the COVID-19 pandemic.

I haven’t seen Oliver in all this time. I only know what’s been happening to him via his father, my uncle. We’re cousins with just two years between us in age, yet Oliver and I have lived through different – often opposing – experiences of mental disorder. While Oliver felt lifted to the heights, I believed that I was worthless, guilty of ruining the lives of others. Far from being heavenly, I felt I was better off dead and buried. This suicidal ideation, combined with a lack of motivation and baseless guilt, is typical of a mood disorder such as depression. Accordingly, doctors prescribed me antidepressants that adjust the neurotransmitter serotonin in my brain, rather than clozapine or another antipsychotic, which target a different brain chemical, dopamine.

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I’ve never been institutionalised or injected with sedatives (although I am prescribed them). I’ve never heard voices in my head. From its symptoms to its treatment, my depression is a gulf apart from Oliver’s schizophrenia. Mine is a mood disorder, not a psychotic disorder. Like the split between animals and plants in biology, these two fundamental categories have been a cornerstone of psychiatry since the work of the German psychiatrist Emil Kraepelin in the late-19th and early 20th centuries. His textbooks laid the foundations for the DSM-5 and the ICD-11 – the latest editions of two reference manuals published by the American Psychiatric Association and the World Health Organization, respectively – that are used by psychiatrists to diagnose hundreds of different mental disorders, each grouped into 20 or so categories: disorders of personality, psychosis, substance use, anxiety, depression, eating, sexual dysfunction and so on.

Since the publication of the DSM-III in 1980, psychiatric diagnosis has helped to select the right treatment for a person’s symptoms. It’s also made the tracking of diagnoses over time and space possible, a field known as ‘psychiatric epidemiology’. However, while these diagnostic guides might be useful for doctors who must make daily decisions about care and treatment, some critics argue that diagnostic systems have actually stymied the progress of psychiatry. While other specialities of medicine have drastically reduced mortality rates from heart disease, cancer and stroke, there haven’t been similar successes in mental healthcare. As a paper from 2013 put it, ‘mortality has not decreased for any mental illness, prevalence rates are similarly unchanged, there are no clinical tests for diagnosis, detection of disorders is delayed well beyond generally accepted onset of pathology, and there are no well-developed preventive interventions.’ In short, psychiatry appears stuck.

Perhaps it’s because the diagnostic system is faulty. Indeed, the fact that around half of patients with one mental disorder also fulfil the requirement for a second disorder has been well documented since the 1990s: major depression and generalised anxiety disorder (GAD), substance use disorders and attention deficit hyperactivity disorder (ADHD), bipolar disorder and schizophrenia. Either mental disorders really do tend to aggregate or, perhaps more likely and more worryingly, our classification system is drawing lines in unnatural places, carving nature far from its joints.

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There’s an alternative approach. A growing troupe of scientists think that focusing on one or two diagnoses in a study – as is common in psychiatric research – has meant that the true nature of mental disorders remains hidden. To understand what are essentially brain disorders, they argue you have to zoom out. Considering the whole spectra of psychiatric possibility reveals similarities in symptoms, brain circuitry and genetics. Shaking off the shackles of diagnostic classification, there is growing evidence that all mental disorders are actually the product of a single underlying dimension, a common liability

digital art icon size 8 5x11 paper

digital art icon size 8 5x11 paper

zonker20566    April 27, 2023    Comment   

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